Medicine's Glass Slipper: The PAVAEX Boot and 20th Century Negative Pressure Therapy.

Before the 20th century, peripheral artery disease (PAD) manifested as extreme pain, chronic wounds, and, eventually, gangrene requiring amputation. Despite this, it was rarely diagnosed. However, at the turn of the century, Western medicine shifted focus from infectious to chronic illnesses, and with this change, physicians' engagement with PAD transformed. Aiming to mitigate long-term injury, physicians now worked to identify and treat vessel disease to restore meaningful blood circulation. This article explores the development and deployment of a new device resulting from this refocus, the PAssive VAscular EXerciser (PAVAEX) Boot, and its role as a creative response to a previously intractable clinical problem. The PAVAEX Boot, designed in 1933 by vascular surgeons Louis G. Herrmann and Mont R. Reid, was one of the few interventions for PAD at the time. Based on the observation that continuous negative pressure results in vasoconstriction, while short bursts transiently increase blood flow, the PAVAEX Boot utilized intermittent negative pressure to enhance peripheral vascular perfusion. Well-marketed and praised throughout the 1930s, it vanished from public writing and academic literature just 20 years later. However, negative pressure wound therapy resurged in the late 20th century, and though its inventors failed to recognize the precedent of the PAVAEX Boot, many of these devices and therapies are rooted in identical theories. We examine why the PAVAEX Boot faded from use and argue that the device remains a crucial advancement in negative pressure therapy.

'Through and Through' History: The Management of Gunshot Wounds From the 14th Century to the Present.

Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. 'Through and Through History' explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.

Anesthesia in the Korean War.

Relying on original, primary source documentation from the National Archives, we describe the practice of anesthesia in mobile army surgical hospital (MASH) units and the 171st Evacuation Hospital during the latter part of the Korean War in 1953. Values were scaled and reported as percentages. These Essential Technical Medical Data Sheets reveal a surprising proportion (12.9%) of men received spinal anesthetics, despite official recommendations to the contrary. Still, the majority (69.2%) of the wounded underwent general anesthesia, most commonly through a mixture of thiopental and nitrous oxide. Despite data from World War II demonstrating the advantages of endotracheal intubation in these patients, few patients (20.6%) were intubated. Six percent benefited from the new curare-based drugs. This is the first English-language article that describes the practice of anesthesia during the Korean War. Utilizing primary source documentation, we found that general anesthesia was the most common type utilized. Newer techniques were not as commonly adopted, despite official recommendations and data from the time. The care provided closely resembled that delivered in the Second World War but inspired a series of technological and pedagogical reforms through the 1950s to improve military anesthesia for the next conflict.

Richard Nixon's Left Knee and Its Impact on American History.

Richard Nixon injured his left knee in a limousine door while campaigning in North Carolina in 1960, resulting in septic arthritis that required a multi-day admission to Walter Reed Hospital. Still ill for the first presidential debate that fall, Nixon lost the contest based more on his appearance than his performance. Partly as a result of this debate, he was defeated by John F. Kennedy in the general election. Because of his leg wound, Nixon developed chronic DVTs in that limb, including a severe thrombus in 1974 that embolized to his lung, required surgery, and prevented him from testifying at the Watergate Trial. Episodes like this one highlight the value of studying the health of famous figures, where even the most minor injuries have the potential to influence world history.

History of Medicine in the Clerkships: A Novel Model for Integrating Medicine and History.

The history of medicine has only unevenly been integrated into medical education. Previous attempts to incorporate the subject have focused either on the first year, with its already over-subscribed curriculum, or the fourth year in the form of electives that reach a small minority of students. Duke University provides an alternative model for other universities to consider. At our institution we have overcome many of the curricular limitations by including history during the mandatory third year clerkships. Reaching 100% of the medical school class, these sessions align with clinical disciplines, providing students a longitudinal perspective on what they are seeing and doing on the hospital wards. They are taught in conjunction with a medical history librarian and rely heavily on the utilization and interpretation of physical artifacts and archival manuscripts. The surgery, obstetrics/gynecology, and pediatrics rotations now feature successful and popular history of medicine sessions. Describing our lesson plans and featuring a list of both physical and online resources, we provide a model others can implement to increase the use, the framing, and the accessibility of history in their medical schools.

Medicine and History: a Surgical Model for National Integration.

Historians and physicians have struggled to incorporate history into American medical education for over a century. Most efforts focus on local initiatives targeting a narrow audience. We describe a novel method involving the American College of Surgeons, a national organization with tens of thousands of members. Capitalizing on its infrastructure and influence over the field, we have implemented a variety of ventures that include panel sessions at meetings, poster competitions, travel grants, themed breakfasts, online communities, and other such projects. This programming has reached thousands of participants, ranging from pre-medical students to retired physicians, and it has increased both the exposure to and production of surgical history. Our article describes the process of establishing this nationally coordinated enterprise in the hopes that other medical specialties can emulate it and further the study of and appreciation for medical history.

Hilliard Seigler, M.D. and the origins of kidney transplantation and immunology at Duke.

The contributions of Dr. Hilliard Seigler to the founding of the Duke kidney transplantation program were considerable in both surgery and immunology. Some of these highlights are summarized based upon interviews with Dr. Seigler by the authors.

Stricken Before Election: Presidential Health Crises From 1880 to 2020.

Between 1880 and today, 6 presidents have suffered major health crises just before their reelection campaigns. Ranging from Chester Arthur's development of Bright's Disease to Donald Trump contracting COVID-19, diseases and their treatments varied considerably. More interesting than the medical management, however, is the political maneuvering around each and the extraordinary lengths Presidents went to demonstrate their health to the American people. This article reviews these episodes, comparing and contrasting how each administration handled their crisis and what effect it had on the ensuing election-and thus the history of the United States.

Harry Truman's Complicated Cholecystectomy.

MINI-ABSTRACT: Harry S. Truman, the 33rd President of the United States, developed right-sided abdominal pain the year after he left office. Misdiagnosed with appendicitis, Truman underwent an appendectomy before a cholecystectomy treated the underlying cholecystitis. This error was concealed at the time from the American people. His postoperative course was closely followed by Americans through newspapers and was complicated by a bout of Clostridium difficile colitis. Truman survived this episode to die of heart failure decades later.

Bottoms Up: A History of Rectal Nutrition From 1870 to 1920.

From the 1870s through the early 20th century, physicians frequently relied upon nutritive enemata to succor patients suffering from bowel obstructions and other disorders of the gastrointestinal system. Far from extraordinary or outlandish, this therapy was used on paupers and presidents alike, including on Garfield and McKinley after their assassination attempts. The medical milieu of the late 19th century provided particularly promising circumstances for its practice, with the rise of allopathic medicine generally-and surgery especially-coinciding with flourishing research on the physiology of nutrition. Although ongoing discussions debated the merits of different methods and various ingredients, few in the United States or Europe doubted the efficacy of rectal alimentation. However, in the early 20th century, new studies utilizing biochemistry demonstrated the inability of such instillations to provide significant calories or protein, and the intervention fell from favor. Proctoclysis-or rectal hydration-remained standard of care for the next 20 years, strongly supported by John B. Murphy and other surgeons. Ultimately, intravenous hydration and, much later, total parenteral nutrition replaced the rectal route.

The Oswald injury.

On November 22, 1963, John F. Kennedy, the 35th president of the United States, was assassinated in Dallas, Texas. John B. Connally, the Governor of Texas, simultaneously was injured in the shooting. Both Kennedy and Connally were transported to and cared for at the Parkland Memorial Hospital. Within 3 hours, the accused assassin, Lee Harvey Oswald, was arrested and taken to the Dallas City Jail in the Downtown Municipal Building. When the authorities were transferring Oswald from the City to the County Jail at midday on November 24, Jack Ruby shot him as the event was televised and broadcast live to the nation. Oswald was rushed to Parkland Memorial Hospital where he was operated on by the same surgeons who had attended Kennedy and Connally 2 days previously. This article reviews the operative treatment that Oswald received before discussing the state of abdominal vascular trauma in the 1960s.

The History of Wound Healing.

Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries.